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New review of neuropathic pain therapies

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    A systematic review and meta-analysis of pharmacotherapy for neuropathic pain has been published in The Lancet Neurology (February 2015).

    229 studies (196 published and 33 unpublished) were included in the meta-analysis. Analysis of publication bias suggested a 10% overstatement of treatment effects. It was found that neuropathic pain trial outcomes were generally modest and placebo responses were typically high.

    On balance, tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, pregabalin, and gabapentin were recommended as first-line treatments. On average, approximately one in seven patients experienced 50% pain relief using these therapies.

    Lidocaine patches (found to have limited evidence) along with capsaicin patches and tramadol were recommended as second-line treatments.

    Among their findings, the authors noted that tolerability and safety, and values and preferences were higher for topical therapies.

    In a linked commentary, Dr David Bennett, Professor of Neurology and Neurobiology at Oxford University said “Overall, present options are far from ideal and new and more efficacious treatments than exist at present are needed for neuropathic pain.”


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